Pneumonia Flashcards
What is the most common organism identified in pneumonia?
Strep Pneumoniae
What are some risk factors for legionella?
Chronic lung disease Smoking Diabetes Immunosuppression Steroids Malignancy ESRF
What population is haemophilus common in?
COPD patients
What is the treatment for mild pneumonia?
Oral amoxycillin or doxycycline if penicillin allergy
What is the treatment for moderate pneumonia?
penicillin (benpen or amoxicillin) + macrolide
Severe pneumonia treatment?
Cephalosporin or betalactamase (augmentin) plus macrolide
What are causes of atypical pneumonia?
Legionella
Mycoplasma
Chylamydia
What is the definition of HAP?
pneumonia in someone hospitalised for greater then 48 hours or has been in hospital within the last 10 days
What organisms are responsible for HAP?
aerobic gram negative bacilli MRSA ESBL Pseudomonas Acinetobacter * atypicals very uncommon
What are possible treatments of HAP?
Depends on risk of MDR Low risk mild - augmentin severe - ceftriaxone with anerobic cover or Iv augmentin High risk Tazocin +/- gentamicin/vancomycin
Micro of aspiration pneumonia?
Often sterile pneumonitis is most common feature early, may be followed by aspiration pneumonia
Strep pneumoniae still most common cause, anerobes occur but are overestimated
When is metronidazole required for aspiration?
severe peridontal disease
alcoholic
abscess
empyema
What is meliodosis?
Burkholderia pseudomallei pneumonia
Where is meliodosis most commonly from?
Tropical areas - north queensland, northern territory, western australia
Peaks in the wet season
Features of melidosis?
abscesses in spleen and prostate
localised cutaneous ulcers, encephalomyelitis
Treatment for melidosis?
Carbapenem, ceftriaxone
What is the mortality from pneumonia depending on severity?
managed in community less than 1%
managed in hospital 6-14%
ICU admission greater then 30%
What is the time course for the resolution of pneumonia?
61% clear at 4 weeks
73% are clear at 6 weeks
slower if elderly, multilobar, bacteremia
What are the most common causes of lung abscess?
Aspiraton - most common, anaerobic bacteria (peptostreptococcus, bacteroides)
Embolic source - from TV endocarditis, lemieres, staph aureus, pseudomonas, fusobacterium
Mycobacterium/fungi
Immunocompromised - Tb, norcardia, legionella, pseudomonas, aspergillus, cryptococcus
Healthy - staph aureus, klebsiella, entamoeba, strongyloides
What is the empiric treatment for lung abcess?
need anerobic coverage - clindamycin, betalactamase or metronidazole plus penicillin
